Beyond blame

As I discussed in my previous blog post, the language of social care is filled with words that blame people seeking and drawing on support.

‘Hard to reach’. ‘Refuses to engage’. ‘Frequent flyers’. ‘Carer breakdown’. ‘Bed blockers’. ‘Challenging behaviour’. ‘Non-compliant’. ‘Complex’. ‘Difficult’. ‘Vulnerable’. And many more.

These terms don’t just feature in our conversations and records. We recruit social workers to work with “non-engagers”, “the most complex and challenging adult cases” and “some of society’s most vulnerable individuals” [1]. We have policies for ‘dealing with difficult families’ and guidance on ‘engaging hard to reach groups’. We have ‘Complex needs teams’ and ‘Challenging behaviour units’. And in the wider world, this language features in news headlines (“Operation Re-set’ launched in south east to clear bed blockers’ [2], “Carers struggling to cope during the pandemic” [3]) and government press releases (“£2.9 billion funding to strengthen care for the vulnerable” [4]).

The irony of course is that so many of these blaming words and phrases can just as easily be applied to ‘service land’. Hard to reach? Yep. Challenging behaviour? Oh yes. Difficult? Sure. Complex? Absolutely.

“During one of the first conferences I’d been asked to speak at, the person before me spoke of the ‘challenging behaviour’ of people with dementia. It made me so sad that I quickly took a pen from my bag and rewrote a section of my speech to talk about the challenging behaviour of healthcare professionals, whose ignorant response distresses us.”

Wendy Mitchell [5]

The language we use reflects our attitudes and influences our behaviours. So, what does this blaming language tell us about our current practice?

Labels close minds. Once applied, they stick, and lead to assumptions and prejudgements. These terms become not just part of the person’s record, but part of their identity. Become their identity.

“After a while, it feels as if you actually cease to exist, swamped by this paper version of yourself which somehow takes on its own life. After a while, it is your “paper-self” who is risk assessed, diagnosed, and treated. After a while, you realise there’s nothing you can do to stop the rise of your paper-self, because every word, every action, every movement you make only adds to its ever-growing and everlasting presence.”

Wren [6]

If we hear or read labels like ‘frequent flyer’, ‘difficult’, ‘complex’ or ‘challenging’ before we’ve even met someone, our response is pre-loaded with assumptions linked to previous encounters, meaning we fail to properly listen or observe or understand what’s happening now, and why.

And in turn our failure to listen or observe or understand leads to solutions and fixes that don’t address the underlying causes, which can have devastating consequences – particularly when behaviour we treat as challenging is actually an expression of pain.

“Imagine feeling severe pain and not understanding what is happening, nor even being able to ask for help and information. That is frequently the case for people with profound learning disabilities who cannot communicate verbally. Yet when distress and anxiety alter their demeanour, it is often dismissed as ‘challenging behaviour’ until the illness causing the pain reveals itself in some other way.”

Jenny Morris [7]

Labels like ‘vulnerable’ prevent us from acknowledging and addressing the circumstances and policies and attitudes and power imbalances that create and perpetuate vulnerability – and may prevent people seeking support too. And terms like ‘difficult’ undoubtedly prevent people from raising concerns – not just for fear of being stigmatised, but also for fear of care and support being removed.

Describing people as ‘non-compliant’ exposes our fixed expectations about what ‘should’ be happening and the ‘we know best’ power dynamic. ‘Carer breakdown’ and ‘bed-blockers’ shifts attention from the failures of our services and support. And terms like ‘hard to reach’ or ‘refuses to engage’ make it easy for us to walk away.

These blaming terms demonstrate and perpetuate the ‘them and us’ divide that pervades our practice.

We know that connection and relationships must be at the beating heart of our better, brighter social care future. And we also know that blame destroys trust, stifles curiosity and sabotages relationships.

So how do we shift this narrative?

How do we move beyond blame?

From blame to accountability

“One of the most insidious ways in which institutions maintain their power to continue to fail is through their tendency to blame individuals for institutional failings. This is woven into public service language.’

Alex Fox [8]

When something doesn’t turn out in the way we hoped or expect, instead of asking why, we ask who? Whose fault is it? Who can we blame?

There’s some element of failure behind every one of the blaming words and phrases I’ve mentioned. While we’re busy blaming people for failing to show up or cope or behave, we’re fundamentally missing the basic point that the failure lies with us. Failure to ask, and understand, and do, what matters most to the people we serve. Failure to identify, listen, empathise, and respond compassionately. Failure to relinquish power and control. Failure to comply with our statutory duties and uphold people’s human rights.

Failure to acknowledge where and how and why we’re failing.

Accountability is essential, but that doesn’t mean we shift the blame and start pointing fingers at colleagues. The blame culture is already far too prevalent and damaging within our organisations. It also doesn’t mean we blame ‘the system’ – because – well, we are the system. And it definitely doesn’t mean we add more tick boxes to our forms to justify our every move. It means we know and follow the law, we’re transparent about our responsibilities and we’re honest about our mistakes and where we need to do better. We acknowledge that we’re still learning, and we welcome – and act on – suggestions about how we improve.

From furious to curious

Blame prevents curiosity, and learning, and change.

Next time you hear or read one of these blaming words or phrases, or say or write one of them yourself, question the label. Then look beyond it, and see and hear the person. Ask yourself what’s really going on here? And why? What’s happened – or happening – to this person? What are they communicating? What’s important to them? What would they like to happen next?

Be aware of the impact of your own behaviour and question your response. What does it say about your own attitudes and assumptions? And in turn what does that tell you about the expectations and operation of the wider system? About where the power and control really lie?

We blame people when things don’t turn out as we expect and when things don’t go to plan. But whose expectations are these? Whose plan are we following?

Whose needs are we really meeting?

From correction to connection

We have to shift our focus from correction to connection. Move from trying to mould people to ‘fit in’ – to ‘engage’, ‘behave’ and ‘comply’ – to meeting people where they’re at, and on their terms. Understanding and accepting and being interested in and caring about people for who they are, and want to be, not who we think they should be, or how we think they should behave.

No assumptions.

No judgement.

No blame.

---

References

[1] Recruiting robots: the language of social work job adverts, Bryony Shannon, Rewriting Social Care, 24 July 2021

[2] ‘Operation Re-set’ launched in south east to clear bed blockers, BBC News, 10 January 2021

[3] Carers struggling to cope during the pandemic, Julia Gregory, London News Online, 10 March 2021

[4] £2.9 billion funding to strengthen care for the vulnerable, Department of Health and Social Care, News story, 19 March 2020

[5] Somebody I used to know, Wendy Mitchell, Bloomsbury, 2018

[6] Mental Health Clinical Notes: The Curse of the Paper-Self, Wren, Psychiatry is driving me mad, 22 August 2021

[7] Communication: Everyone’s human right, Jenny Morris, Rightful Lives

[8] A new health and care system, Alex Fox, 2018